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General NPI Number Information
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NPI Number | 1245473503
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Entity Type | Individual
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Provider Name | JESSICA WELT-BETENSKY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 2009 SUMMER ST STE 202
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City | STAMFORD
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State | CT
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Zip | 06905-5023
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Country | US
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Telephone | 914-588-7177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22 26 VILLAGE GRN STE 4
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City | BEDFORD
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State | NY
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Zip | 10506-0022
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Country | US
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Telephone | 914-588-7177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 017406-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 003210
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License Number State | CT
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